| NPI | 1215076971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60117918) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G85310) |
| 208600000X Surgery (Licence: CA G85310) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2011-12-06 |