| NPI | 1962715094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A134495) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: TX Q9839) |
| 208600000X Surgery (Licence: TX Q9839) | |
| Enumeration Date | 2010-07-18 |
| Last Update Date | 2026-01-27 |