| NPI | 1255625703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 55965) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: TN 55965) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2022-03-22 |