| NPI | 1467713867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60967810) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD185420) |
| 2086S0102X Surgery Surgical Critical Care (Licence: OR MD185420) | |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2019-08-22 |