| NPI | 1285832956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60337677) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD157519) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2013-11-05 |