| NPI | 1396713962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00034378) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD24006) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2020-02-14 |