| NPI | 1164404620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 83687) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME0062882) |
| 2086S0127X Surgery, Trauma Surgery (Licence: NM MD2005-0136) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2022-11-02 |