| NPI | 1861467474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD25193) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD25193) |
| 208600000X Surgery (Licence: WA MD61412741) | |
| Enumeration Date | 2006-02-18 |
| Last Update Date | 2023-04-24 |