| NPI | 1184668287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME0077597) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: FL ME0077597) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2007-07-09 |