| NPI | 1215116850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 52757) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME115864) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME115864) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: SC 52757) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: FL ME115864) | |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2022-01-04 |