| NPI | 1477501104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.088080) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00044204) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2023-02-02 |