| NPI | 1245587823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD182725) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60773408) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2023-12-07 |