| NPI | 1821078379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C167415) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2010008190) |
| 208600000X Surgery (Licence: WA MD60221749) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2020-01-16 |