| NPI | 1356784755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AK 195771) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60568406) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: AK 195771) | |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2022-10-06 |