| NPI | 1376629139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD00032034) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00032034) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2011-08-19 |