| NPI | 1609036136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60465002) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2016038669) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2024-10-21 |