| NPI | 1154366300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60641501) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD422547) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2018-03-17 |