| NPI | 1245452549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 55044) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57 . 007362) |
| 2086S0127X Surgery Trauma Surgery (Licence: WI 55044) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: WI 55044) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2014-06-20 |