| NPI | 1669636007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: MI 4301116543) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NE 26638) |
| 2086S0127X Surgery, Trauma Surgery (Licence: NE 26638) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2020-01-10 |