| NPI | 1174822613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: WA MD60370191) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60370191) |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2019-06-20 |