| NPI | 1356602221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: TX T0969) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2013037319) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2023-07-17 |