| NPI | 1205063435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: TX BP10034012) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10034012) |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2021-11-17 |