| NPI | 1861682056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: HI MD-17435) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA md60311764) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2019-03-19 |