| NPI | 1447483565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60509370) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL unknown) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2015-10-28 |