| NPI | 1285920223 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: ID O-1974) | 
| Additional Taxonomies | 208600000X Surgery (Licence: SC 52097) | 
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX R4098) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: SC 52097) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: GA 076864) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: TX R4098) | |
| Enumeration Date | 2011-06-28 | 
| Last Update Date | 2024-05-14 |