| NPI | 1588828859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA OP60653386) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: HI DOS-1320) |
| 208D00000X General Practice (Licence: HI DOS-1320) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2020-12-09 |