| NPI | 1336365295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD15379) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00034655) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2007-07-08 |