| NPI | 1750794517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61059349) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR 125064540) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2020-10-14 |