| NPI | 1770663023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA 41247) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX H6252) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: IA 41247) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: IA 41247) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2013-08-20 |