| NPI | 1114388154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: MD D08592) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: TX T8342) |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2023-12-05 |