| NPI | 1053522094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA OP60151380) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 127348) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2010-07-15 |