| NPI | 1598073181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: TX T9464) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101251259) |
| 2086S0102X Surgery Surgical Critical Care (Licence: FL ME146116) | |
| Enumeration Date | 2010-09-17 |
| Last Update Date | 2024-05-03 |