| NPI | 1164454484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00047592) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 31089) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-04-29 |