| NPI | 1245674225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2023-01390) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: WA MD60977216) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2023-07-20 |