| NPI | 1548553456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: MO 2019030236) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN17863) |
| 2086S0127X Surgery, Trauma Surgery (Licence: CO 0064724) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2022-05-11 |