| NPI | 1265524912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G23099) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00045810) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2007-07-08 |