| NPI | 1114933777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.122389) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00046923) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: AR E-6714) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2020-07-06 |