| NPI | 1033477070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: WI 73380) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX S1265) |
| 208600000X Surgery (Licence: WI 73380) | |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2021-02-08 |