| NPI | 1841277845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00015916) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00015916) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2012-03-28 |