| 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 |