| NPI | 1093789372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61007212) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61007212) |
| 208600000X Surgery (Licence: OR MD163726) | |
| 208600000X Surgery (Licence: AK 4748) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-06-08 |