| NPI | 1275619637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00030182) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD17856) |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2015-12-10 |