| NPI | 1750676490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA OP60646987) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 94-07682) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2022-06-15 |