| NPI | 1396881496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME165167) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00042285) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2023-12-29 |