| NPI | 1346248861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ND 19326) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00026616) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2024-03-12 |