| NPI | 1366624330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 12168421-1204) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 20A12096) |
| 208600000X Surgery (Licence: WA OP60582410) | |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2021-06-15 |