| NPI | 1013449636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY TP871) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: AL 46773) |
| 208D00000X General Practice (Licence: NE 31147) | |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2023-11-07 |