| NPI | 1821294588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 46280) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: KY 46280) |
| 2086S0127X Surgery, Trauma Surgery (Licence: GA 85056) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: WV 24131) | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2023-09-20 |