| NPI | 1609212919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: CA 16594) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA OP60970901) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2021-01-08 |