| NPI | 1376907436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD61424785) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD61424785) |
| 208600000X Surgery (Licence: NC 2018-01861) | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2023-09-08 |