| NPI | 1205852803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101241736) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 36741) |
| 2086S0127X Surgery Trauma Surgery (Licence: IA 36741) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2022-10-20 |