| NPI | 1497707178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: UT 6634572-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 6634572-1205) |
| 2086S0127X Surgery Trauma Surgery (Licence: WI 45679) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2021-11-09 |