| NPI | 1215328976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: TX W3214) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 31987) |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2026-04-30 |