| NPI | 1619404415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME161768) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: FL ME161768) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-04-11 |