| NPI | 1518943265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: ID M-16547) |
| Additional Taxonomies | 2086S0129X (Licence: CA A78144) |
| 2086S0129X (Licence: ND 18532) | |
| 208600000X Surgery (Licence: WA MD60676859) | |
| 2086S0129X (Licence: WA MD60676859) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2025-09-24 |