| NPI | 1750350971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD190456) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00042199) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2019-02-20 |