| NPI | 1558604033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2021-0787) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60668601) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2023-11-01 |