| NPI | 1356346936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CO CDR.0001339) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60422790) |
| 2086S0129X (Licence: WA MD60422790) | |
| 2086S0129X (Licence: AZ 61178) | |
| 2086S0129X (Licence: ID MC-0454) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2025-02-20 |