| NPI | 1720463979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME135963) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME135963) |
| 2086S0127X Surgery, Trauma Surgery (Licence: OK 39010) | |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2023-09-19 |