| NPI | 1235542648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: MA 278169) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP03177) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2020-09-29 |