| NPI | 1710203518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: LA 305385) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: LA 305385) |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2021-02-05 |