| NPI | 1861515165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OK 34066) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX M0664) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OK 34066) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: OH 35.122564) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: OK 34066) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2022-09-01 |