| NPI | 1053815340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2025029372) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: MO 2025029372) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2025-11-05 |