| NPI | 1831131432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TN MD15114) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: VA 010140493) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2008-03-05 |