| NPI | 1275714008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: CT 54313) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 135726) |
| 208600000X Surgery (Licence: CT 54313) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD450778) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: CT 54313) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: PA MD450778) | |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2015-07-21 |