| NPI | 1225324353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: MD D0096416) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MD D0096416) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2024-10-01 |