| NPI | 1811168073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: PA OS016234) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 001982) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2020-08-17 |