| NPI | 1386092773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 77034) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD.MD.61429679) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2024-09-17 |