| NPI | 1497074041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2013-00327) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: PA OS014259) |
| 2086S0127X Surgery Trauma Surgery (Licence: PA OS014259) | |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2021-05-11 |