| NPI | 1861786022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60775245) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA 60775245) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2020-12-01 |