| NPI | 1548330723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WY 7202A) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: WY 7202A) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2012-06-21 |