| NPI | 1730509837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: MD D0088201) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MD D0088201) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MD D0088201) | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2020-01-30 |