| NPI | 1073611489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD00032892) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: WA MD00032892) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-10-30 |