| NPI | 1649282922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00020229) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 044943) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2013-09-03 |