| NPI | 1164488946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: WI 63678-20) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: CA G72140) |
| 2086S0129X Surgery, Vascular Surgery (Licence: CA G72140) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2023-08-11 |