| NPI | 1407990070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60153817) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 41382) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2011-12-02 |