| NPI | 1871537001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60999385) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 123597) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2020-02-05 |