| NPI | 1356668594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60755879) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR 177245) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2022-07-21 |