| NPI | 1285799668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60101109) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301045288) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2023-10-06 |