| NPI | 1770781437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60627845) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO 45825) |
| 208600000X Surgery (Licence: ID M-10914) | |
| Enumeration Date | 2007-07-04 |
| Last Update Date | 2016-05-12 |