| NPI | 1003873993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2010-01514) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: PA MD067156L) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2016-09-23 |