| NPI | 1790920775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: VA 0102205056) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 2867) |
| 208D00000X General Practice (Licence: PA OT012535) | |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2021-08-11 |