| NPI | 1376839167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: CA 20A12099) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 5482) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2026-06-09 |