| NPI | 1417214404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: WI 83305-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2016-01904) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2024-07-16 |