| NPI | 1164714127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R1500) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: TX R1500) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2021-02-03 |