NPI | 1013145697 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: UT 9743925-1204) |
Additional Taxonomies | 171000000X Military Health Care Provider |
208600000X Surgery (Licence: NC 2015-02260) | |
Enumeration Date | 2009-06-23 |
Last Update Date | 2019-04-03 |