| NPI | 1417921735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: LA 338699) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101235183) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MD D0068876) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: MD D0068876) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2023-09-22 |