| NPI | 1871766600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD168558) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML60093926) |
| Enumeration Date | 2008-04-13 |
| Last Update Date | 2021-03-25 |