| NPI | 1417991084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 30185-020) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60287580) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2014-02-25 |