| NPI | 1508120882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 70708) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 92894) |
| 2086S0127X Surgery, Trauma Surgery (Licence: GA 70708) | |
| Enumeration Date | 2012-07-01 |
| Last Update Date | 2026-06-01 |