| NPI | 1699153866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 84953-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD61186271) |
| 208D00000X General Practice (Licence: NE 29587) | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2025-12-29 |