| NPI | 1215944129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61055807) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND 17101) |
| 208600000X Surgery (Licence: CA A90424) | |
| 208600000X Surgery (Licence: CO DR.0052704) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2021-12-07 |