| NPI | 1326153040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD00045085) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00045085) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2012-02-08 |