| NPI | 1316020704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA OP60824491) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI DOS-1130) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: WA OP60824491) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2025-05-02 |