| NPI | 1962481655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WY 8753A) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A93051) |
| 2086S0127X Surgery Trauma Surgery (Licence: CA A93051) | |
| 2086S0127X Surgery Trauma Surgery (Licence: WY 8753A) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: WY 8753A) | |
| 2086S0129X Surgery Vascular Surgery (Licence: WY 8753A) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2011-07-20 |