| NPI | 1457765232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA OP60950081) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101021096) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2020-12-09 |