| NPI | 1588640858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: UT 9803062-1205) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: UT 9803062-1205) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2025-01-31 |