| NPI | 1568513703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00039844) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00039844) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2010-06-14 |