| NPI | 1124448162 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208600000X Surgery (Licence: MD D91256)  | 
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: VA 1124448162)  | 
| Enumeration Date | 2014-04-17 | 
| Last Update Date | 2025-09-09 |