| NPI | 1841349073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M10966) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00022191) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2012-09-18 |