| NPI | 1841290947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: WA MD00014269) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00014269) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2020-04-07 |