| NPI | 1366738312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60848138) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2017-00874) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD60848138) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2018-09-20 |