| NPI | 1649264680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60266560) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD418192) |
| 2086S0127X Surgery, Trauma Surgery (Licence: OR MD161541) | |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2023-05-18 |