| NPI | 1720174584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 15137) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: WV 15137) |
| 2086S0127X Surgery, Trauma Surgery (Licence: WV 15137) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: KY TP130) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: KY TP130) | |
| 208600000X Surgery (Licence: KY TP103) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2013-05-31 |