| NPI | 1649314998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX G7824) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TX G7824) |
| 2086S0127X Surgery, Trauma Surgery (Licence: TX G7824) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: TX G7824) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2014-01-14 |