| NPI | 1801930201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60026209) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 233186) |
| Enumeration Date | 2007-02-18 |
| Last Update Date | 2008-08-14 |