| NPI | 1952503989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD189436) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60901402) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: WA MD60901402) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OR MD189436) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: OR MD189436) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: WA MD60901402) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2019-12-04 |