| NPI | 1407862410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: ID M-14304) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: TX m5718) |
| 2086S0127X Surgery, Trauma Surgery (Licence: AZ 40382) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2018-09-24 |