| NPI | 1730494741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: NV 20465) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2013-02230) |
| 208600000X Surgery (Licence: MA 268463) | |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2021-05-26 |