| NPI | 1376600346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A129104) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD 60020405) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2025-09-08 |