| NPI | 1871912519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A140169) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: CA A140169) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2019-11-11 |