| NPI | 1629143144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 29945) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: AZ 29945) |
| 208600000X Surgery (Licence: CA G88791) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2015-05-22 |