| NPI | 1295718385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00047673) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M- 10599) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2013-10-29 |