| NPI | 1669719258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: WA OP61468237) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX V5712) |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2025-10-24 |