| NPI | 1497915847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: ME MD22043) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60561274) |
| 208600000X Surgery (Licence: CA A104159) | |
| 2086S0129X (Licence: NH 19628) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2025-12-04 |