| NPI | 1801117445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: VA 0101250183) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101250183) |
| 2086S0127X Surgery, Trauma Surgery (Licence: OH 35.146830) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2025-08-26 |