NPI | 1013987064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: MO R8D67) |
Additional Taxonomies | 208600000X Surgery (Licence: NE 16268) |
208D00000X General Practice (Licence: KS 04-19991) | |
Enumeration Date | 2006-01-24 |
Last Update Date | 2019-12-05 |