| NPI | 1972528305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: CA A111964) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A111964) |
| 2086S0127X Surgery, Trauma Surgery (Licence: CA A111964) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2016-03-23 |