| NPI | 1679674915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 135004) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 135004) |
| 2086S0127X Surgery Trauma Surgery (Licence: NY 135004) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: NY 135004) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2016-10-19 |