| NPI | 1114981453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD 60068314) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 33427) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2012-02-09 |