| NPI | 1992265516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61456025) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA 60959612) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-01-08 |