| NPI | 1114337466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60946286) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD198666) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2020-08-27 |