| NPI | 1245674043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD61055505) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2018-01537) |
| 208600000X Surgery (Licence: OR MD205243) | |
| 208600000X Surgery (Licence: WA MD61055505) | |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2021-10-14 |