NPI | 1104280718 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD61679161) |
Additional Taxonomies | 208600000X Surgery (Licence: WA MD61679161) |
2086S0127X Surgery, Trauma Surgery (Licence: WA MD61679161) | |
Enumeration Date | 2016-04-09 |
Last Update Date | 2025-08-20 |