| NPI | 1184002255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: CT 69111) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: CT 17428093) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2021-07-28 |