| NPI | 1619056520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA WA MD00027001) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR OR MD16429) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-07-08 |