| NPI | 1396904777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: NC 02164) |
| Additional Taxonomies | 208600000X Surgery (Licence: MT 45002) |
| 208600000X Surgery (Licence: NC 2018-02164) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MT 45002) | |
| 208D00000X General Practice (Licence: HI 15599) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2025-08-18 |