| NPI | 1932455136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: WI 69439-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME132260) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2019-10-12 |