NPI | 1114593761 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: PA MD485846) |
Additional Taxonomies | 208600000X Surgery (Licence: PA MT225045) |
208600000X Surgery (Licence: SC MMD.86246LL) | |
Enumeration Date | 2021-06-02 |
Last Update Date | 2024-06-26 |