| NPI | 1235584293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: KY TP511) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.068051) |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2025-08-05 |