| NPI | 1851612683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: HI MD-21438) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208600000X Surgery (Licence: NC 2011-01265) | |
| 2086S0127X Surgery Trauma Surgery (Licence: TX R9578) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2021-08-05 |