| NPI | 1386858751 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208600000X Surgery (Licence: IA 41203) | 
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: IA 41203) | 
| 2086S0102X Surgery, Surgical Critical Care (Licence: IA 41203) | |
| 208600000X Surgery (Licence: PA MT184333) | |
| 208600000X Surgery (Licence: MD D74581) | |
| Enumeration Date | 2007-05-09 | 
| Last Update Date | 2013-08-20 |