| NPI | 1568757870 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: TX S5055) | 
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TX S5055) | 
| Enumeration Date | 2011-06-15 | 
| Last Update Date | 2024-06-06 |