| NPI | 1255727863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: AZ 70554) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: AZ 70554) |
| 2083A0100X Preventive Medicine Aerospace Medicine (Licence: AZ 70554) | |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2023-07-24 |