| NPI | 1164405270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: MI EMC0000656) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID MC-0787) |
| 208600000X Surgery (Licence: MA 219511) | |
| 208600000X Surgery (Licence: ME MD23567) | |
| 208600000X Surgery (Licence: NC 2006-01252) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: TX V4068) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2025-04-17 |