| NPI | 1073662508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00010361) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA 10361) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2013-01-24 |