| NPI | 1891914370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: WA 14276) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: WA 14276) |
| 2086S0127X Surgery, Trauma Surgery (Licence: WA 14276) | |
| 208600000X Surgery (Licence: WA 14276) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2011-07-08 |