| NPI | 1851680466 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: MD D89722)  | 
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: PA MD464252)  | 
| Enumeration Date | 2011-04-04 | 
| Last Update Date | 2020-09-14 |