| NPI | 1811964406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101243351) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 24318) |
| 2086S0127X Surgery, Trauma Surgery (Licence: VA 0101243351) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2021-06-10 |