| NPI | 1467563965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN MD48348) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00046764) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-03-07 |