| NPI | 1497918296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 31160) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL31160) |
| 2086S0102X Surgery Surgical Critical Care (Licence: TX P6535) | |
| 2086S0127X Surgery Trauma Surgery (Licence: TX P6535) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2021-01-05 |