| NPI | 1366701229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 292811) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.130486) |
| 2086S0127X Surgery, Trauma Surgery (Licence: IL 03613822) | |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2020-04-28 |