| NPI | 1982964375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: ND 24187) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2026-01707) |
| 208600000X Surgery (Licence: PA OS017640) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: PA OS017640C) | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2026-05-27 |