| NPI | 1518118678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 68579) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: GA 68579) |
| 208600000X Surgery (Licence: WA MD61103790) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: WA MD61103790) | |
| 2086S0105X Surgery Surgery of the Hand (Licence: GA 68579) | |
| 2086S0127X Surgery Trauma Surgery (Licence: GA 68579) | |
| 2086S0127X Surgery Trauma Surgery (Licence: WA MD61103790) | |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2022-02-07 |