| NPI | 1922191576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS012601) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 1713) |
| 208600000X Surgery (Licence: NY 247174) | |
| 2086S0127X Surgery Trauma Surgery (Licence: WV 1713) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-03-01 |