| NPI | 1104289347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35146344) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 327035) |
| 2086S0127X Surgery, Trauma Surgery (Licence: OH 35146344) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: LA 330326) | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2022-11-16 |