| NPI | 1336219476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 263) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD0000290406) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2018-11-28 |