| NPI | 1225324353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: VA 01225324353) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: VA 0101253443) |
| 171000000X Military Health Care Provider (Licence: MD D0096416) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2025-11-18 |