| NPI | 1619039245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208600000X Surgery (Licence: NV 8648) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: NV 8648) |
| 2086S0102X Surgery Surgical Critical Care (Licence: NV 8648) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2016-01-14 |