| NPI | 1568638104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C196648) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00049425) |
| Enumeration Date | 2008-05-04 |
| Last Update Date | 2025-09-18 |