| NPI | 1912923574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301063260) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301063260) |
| 2086S0127X Surgery, Trauma Surgery (Licence: NY 219095) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2020-01-27 |