NPI | 1194767509 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: WA MD60360724) |
Additional Taxonomies | 208600000X Surgery (Licence: NM MD2004-0818) |
208600000X Surgery (Licence: MT 4310) | |
Enumeration Date | 2006-06-11 |
Last Update Date | 2019-04-25 |