| NPI | 1184030322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: NC 2022-01442) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL38517) |
| 208600000X Surgery (Licence: GA 86162) | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2022-10-05 |