NPI | 1508196130 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: WA OP60500323) |
Additional Taxonomies | 208600000X Surgery (Licence: KY 05379) |
Enumeration Date | 2010-01-04 |
Last Update Date | 2023-01-22 |