| NPI | 1548202088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00024635) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR OR42136) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2007-12-07 |