| NPI | 1699980367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MT 131349) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA OP60226290) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2024-08-06 |