| NPI | 1114098019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A62124) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301104082) |
| 208600000X Surgery (Licence: WA MD60473206) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2016-04-08 |