| NPI | 1326209511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: LA 309285) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA HS000239L) |
| 208600000X Surgery (Licence: LA 309285) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2018-09-12 |