| NPI | 1063527471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60653027) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD60653027) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OR MD20110) | |
| 208600000X Surgery (Licence: OR MD20110) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2020-12-03 |