| NPI | 1629242623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD451464) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 0000049291) |
| 2086S0127X Surgery Trauma Surgery (Licence: TN 0000049291) | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2018-03-17 |