| NPI | 1952394017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD14155) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00037237) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2013-09-19 |