| NPI | 1982137378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD223869) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD048181) |
| 2086S0127X Surgery, Trauma Surgery (Licence: OR MD223869) | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2025-08-13 |