| NPI | 1689932998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0100505) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301117516) |
| 2086S0127X Surgery, Trauma Surgery (Licence: FL ME136215) | |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2024-08-15 |