| NPI | 1841581287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61026165) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 27042) |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2021-04-19 |