| NPI | 1518948447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AK MEDS7502) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60832644) |
| 208600000X Surgery (Licence: CO 37815) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2025-12-03 |