| NPI | 1972581437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD23277) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00032320) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2023-04-24 |