| NPI | 1831149749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C147555) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00018812) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2020-06-05 |