| NPI | 1154359065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60394901) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: CA A83233) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2014-09-04 |