| NPI | 1063446672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: WA MD60272442) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 23646) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2013-12-26 |