| NPI | 1265515043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60066486) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 9300547) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2021-07-16 |