| NPI | 1588075485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: PA OS020434) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT015829) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2020-09-25 |