| NPI | 1467569160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD12835) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00034528) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2007-07-08 |