| NPI | 1609074160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: WI 73750) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 48839) |
| 208600000X Surgery (Licence: KY TP752) | |
| 208600000X Surgery (Licence: OH 89956) | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2020-12-28 |