| NPI | 1851430870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2013-0287) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60072876) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2016-02-17 |