| NPI | 1801874318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00031155) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD150181) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2024-01-08 |