| NPI | 1548207988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00024466) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00024466) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2011-11-18 |