| NPI | 1649203118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101057211) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: WI 61708-20) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2021-09-24 |