| NPI | 1720320641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: FL ME135715) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME135715) |
| Enumeration Date | 2013-03-18 |
| Last Update Date | 2021-03-29 |