| NPI | 1164579983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61313407) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 23368) |
| 208600000X Surgery (Licence: MO 2013022998) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2023-01-05 |