| NPI | 1780889808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60494758) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 61486-20) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2023-04-14 |