| NPI | 1538143292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60891541) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD22272) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2020-12-03 |