| NPI | 1689032005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: WA 00020821) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA 00020821) |
| Enumeration Date | 2016-01-30 |
| Last Update Date | 2016-01-31 |