| NPI | 1649229634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D42181) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC 19033) |
| 2086S0127X Surgery, Trauma Surgery (Licence: MD BD42181) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2014-11-10 |