| NPI | 1407890015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: VA 0102203702) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: AL DO.2452) |
| 171000000X Military Health Care Provider | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NE 488) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TN 2548) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-04-25 |