| NPI | 1457695546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61166228) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD187304) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2022-08-05 |