| NPI | 1033369012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA OP60236670) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036-121383) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2012-11-28 |