| NPI | 1518942085 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208600000X Surgery (Licence: TX M5761) | 
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: TX M5761) | 
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX M5761) | |
| Enumeration Date | 2005-12-07 | 
| Last Update Date | 2022-01-04 |