| NPI | 1871534594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00033975) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR OR155989) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2007-12-07 |