| NPI | 1750380846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2018-0066) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2011013600) |
| 208600000X Surgery (Licence: MN 46583) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MO 2011013600) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: MO 2011013600) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2018-06-11 |