| NPI | 1174759955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: CA A122862) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301090742) |
| Enumeration Date | 2009-06-07 |
| Last Update Date | 2015-02-20 |