| NPI | 1366688632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: IL 036-137623) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 1685718) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: WA OP61206112) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: IL 1685718) | |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2022-05-23 |