| NPI | 1356504831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 44637) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: KY 44637) |
| 2086S0127X Surgery, Trauma Surgery (Licence: KY 44637) | |
| Enumeration Date | 2008-07-06 |
| Last Update Date | 2021-12-07 |