| NPI | 1336468404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD195974) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60660136) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2025-01-21 |