| NPI | 1518288240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OK MD37022) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR PG158260) |
| 208600000X Surgery (Licence: WA ML60164031) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2022-04-21 |