| NPI | 1316212418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N8658) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: TX N8658) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2015-12-04 |