| NPI | 1255326195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: PA MD069369L) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200200098) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2023-10-12 |