| NPI | 1730508326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: VA 0101276706) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: PA MD470930) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2023-01-20 |