| NPI | 1417155086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: WA MD61286229) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 44866) |
| 208600000X Surgery (Licence: ID M-13235) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: ID M-13235) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2025-10-24 |