| NPI | 1265921761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: TX W0191) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT214900) |
| 208600000X Surgery (Licence: MD D0100211) | |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2025-08-05 |