| NPI | 1255541504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P8530) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: LA 025375) |
| 208600000X Surgery (Licence: CA A100317) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-05-17 |