| NPI | 1992233761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: PA MD482959) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.136025) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2023-10-11 |