| NPI | 1588822951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60621759) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD435249) |
| 208600000X Surgery (Licence: OR MD153600) | |
| Enumeration Date | 2008-06-01 |
| Last Update Date | 2016-04-01 |