| NPI | 1568604304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60224925) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID MC-2858) |
| 208600000X Surgery (Licence: ND 21144) | |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2024-10-07 |