| NPI | 1184792079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: CA A62260) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A62260) |
| 208600000X Surgery (Licence: CA A62260) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: CA A62260) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2014-11-20 |