| NPI | 1477719045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD61148385) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD61148385) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2025-05-02 |