| NPI | 1902352107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 96248) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD 7125) |
| 2086S0127X Surgery, Trauma Surgery (Licence: GA 96248) | |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2023-09-01 |