| NPI | 1669429700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD166621) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00019884) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2015-04-08 |