| NPI | 1669687562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-17146) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 145506) |
| 208600000X Surgery (Licence: WA MD60196920) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2023-05-08 |