| NPI | 1588918205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 73636) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301100859) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NV 17312) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: MN 73636) | |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2023-05-24 |