| NPI | 1467657890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: FL ME126820) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: VA 0101249902) |
| 2086S0127X Surgery, Trauma Surgery (Licence: VA 0101249902) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: DC MD 041906) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: NC 2009-00306) | |
| Enumeration Date | 2007-06-16 |
| Last Update Date | 2020-06-30 |