| NPI | 1285618314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD608888682) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 038803) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2018-09-19 |