NPI | 1215202148 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: SC 24920) |
Additional Taxonomies | 208600000X Surgery (Licence: AZ 28781) |
208600000X Surgery (Licence: FL ME60501) | |
208600000X Surgery (Licence: LA MD.017477) | |
Enumeration Date | 2012-03-09 |
Last Update Date | 2012-03-09 |