| NPI | 1750601357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: LA 310177) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: KY 49211) |
| 2086S0127X Surgery Trauma Surgery (Licence: LA 310177) | |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2021-03-24 |