NPI | 1255782603 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: VA 0102207564) |
Additional Taxonomies | 208600000X Surgery (Licence: MI 5101022779) |
208600000X Surgery (Licence: LA 326253) | |
Enumeration Date | 2016-06-27 |
Last Update Date | 2024-04-26 |