| NPI | 1659309797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60951718) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2010008620) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2021-05-18 |