| NPI | 1285054932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: WA MD70061275) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI 20382) |
| 208600000X Surgery (Licence: WY TL5970) | |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2026-01-21 |