| NPI | 1609606912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: VA 0110010656) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110010656) |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2025-12-24 |