| NPI | 1912254392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60880399) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 14193088-1205) |
| Enumeration Date | 2012-08-05 |
| Last Update Date | 2024-12-18 |