| NPI | 1891010872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD60848137) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA 60848137) |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2023-05-02 |