| NPI | 1912252883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: NC 2012-00804) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: NC 2012-00804) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2012-07-17 |