| NPI | 1295711141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 32957) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60178868) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2014-02-13 |