| NPI | 1679661136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-4242) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00045914) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2008-12-16 |