| NPI | 1649834193 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208600000X Surgery (Licence: MN 76747) | 
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MN 76747) | 
| 2086S0127X Surgery, Trauma Surgery (Licence: MN 76747) | |
| Enumeration Date | 2019-04-30 | 
| Last Update Date | 2025-09-29 |