| NPI | 1861655581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: WI 69623) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301092616) |
| 2088P0231X (Licence: WA MD60449464) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2023-06-13 |