| NPI | 1821071648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00046709) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 024232) |
| 208600000X Surgery (Licence: LA MD.024232) | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2021-05-25 |