| NPI | 1992888705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M2959) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00012565) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2008-05-13 |