| NPI | 1801089016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036.125266) |
| Additional Taxonomies | 208600000X Surgery (Licence: PR 12893) |
| 2086S0102X Surgery Surgical Critical Care (Licence: IL 036125266) | |
| 2086S0127X Surgery Trauma Surgery (Licence: IL 036.125266) | |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2022-05-13 |