| NPI | 1396309662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 250077) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: NC 250077) |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2025-01-28 |