| NPI | 1023085511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 47459) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: TN 34611) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2010-03-29 |