| NPI | 1942628391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA ML60475210) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD1192811) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2023-10-27 |