| NPI | 1952345514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00044186) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00044186) |
| 174400000X Specialist (Licence: ID M8333) | |
| 208600000X Surgery (Licence: ID M8333) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2020-09-11 |