| NPI | 1457321739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD33795) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: WA MD33795) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2011-10-07 |