| NPI | 1902153661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R2614) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301109153) |
| 208600000X Surgery (Licence: AL MD.35888) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: AL MD.35888) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX R2614) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: AL MD.35888) | |
| Enumeration Date | 2012-08-12 |
| Last Update Date | 2022-07-21 |