| NPI | 1518963347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: WI 55941) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 55941) |
| 208600000X Surgery (Licence: NJ 59285) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NJ 59285) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: WI 55941) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: NJ 59285) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2022-11-17 |