| NPI | 1770506453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WA MD00021680) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00021680) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2010-05-10 |