NPI | 1609212919 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: CA 16594) |
Additional Taxonomies | 208600000X Surgery (Licence: WA OP60970901) |
Enumeration Date | 2013-05-14 |
Last Update Date | 2021-01-08 |