| NPI | 1770936510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NC 2016-01236) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2016-01236) |
| 2086S0127X Surgery, Trauma Surgery (Licence: NC 2016-01236) | |
| Enumeration Date | 2016-07-17 |
| Last Update Date | 2017-01-12 |