| NPI | 1023212982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60855728) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A101948) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2021-06-15 |