| NPI | 1790945418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD166346) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD61183692) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OR MD166346) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD61183692) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2021-08-31 |