| NPI | 1568645703 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: LA 306992) | 
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: NC 2011-01800) | 
| Enumeration Date | 2007-12-11 | 
| Last Update Date | 2018-03-17 |