| NPI | 1497866990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G79111) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: CA G79111) |
| 2086S0127X Surgery Trauma Surgery (Licence: CA G79111) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-09-17 |