| NPI | 1619131125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101273388) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 65942) |
| 2086S0127X Surgery, Trauma Surgery (Licence: FL ME111163) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2021-11-02 |