| NPI | 1629234547 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: GA 057896) | 
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: GA 057896) | 
| Enumeration Date | 2008-07-30 | 
| Last Update Date | 2008-07-30 |