| NPI | 1255530309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TX Q5178) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX Q5178) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2023-03-24 |