| NPI | 1700874351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60413221) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G81484) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2015-02-10 |