| NPI | 1518353044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 13002841-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD.MD.61062859) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2023-03-27 |