| NPI | 1700996824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2017020795) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-27877) |
| 2086S0102X Surgery Surgical Critical Care (Licence: KS 04-27877) | |
| 2086S0127X Surgery Trauma Surgery (Licence: KS 04-27877) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2018-04-10 |