| NPI | 1851319545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N8370) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60331556) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-03-07 |