| NPI | 1548380488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR DO214315) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: NY 236692) |
| 208D00000X General Practice (Licence: NY 236692) | |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2023-06-06 |