| NPI | 1508171570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD208986) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD208986) |
| 2086S0102X Surgery Surgical Critical Care (Licence: WA MD208986) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: OR MD208986) | |
| 208600000X Surgery (Licence: CA A118403) | |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2022-06-08 |