| NPI | 1659342509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR DO23244) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 20A4923) |
| 208600000X Surgery (Licence: WA OP00000951) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2007-08-25 |