| NPI | 1356306658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: MI 4301075583) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MI 4301075583) |
| 208600000X Surgery (Licence: MI 4301075583) | |
| 208600000X Surgery (Licence: PA MD457338) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD457338) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2020-04-13 |