| NPI | 1417393489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61152193) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD61152193) |
| 2086S0127X Surgery, Trauma Surgery (Licence: TN 60912) | |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2025-07-21 |