| NPI | 1679005722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD61545150) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM MD-2023-0347) |
| 208600000X Surgery (Licence: WA MD61545150) | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2025-02-25 |