| NPI | 1417949926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD24533) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00047700) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2013-03-19 |