| NPI | 1114188950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: AZ 008470) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 208600000X Surgery (Licence: AZ 008470) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2025-07-17 |