| NPI | 1205068111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TX Q4901) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D60466) |
| 2086S0127X Surgery, Trauma Surgery (Licence: TX Q4901) | |
| Enumeration Date | 2009-08-12 |
| Last Update Date | 2019-06-12 |