| NPI | 1619056371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD00017482) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00017482) |
| 2086S0127X Surgery, Trauma Surgery (Licence: WA MD00017482) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2011-08-17 |