NPI | 1265728638 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10177100) |
Additional Taxonomies | 208600000X Surgery (Licence: MI 4301099228) |
208600000X Surgery (Licence: OH 35129604) | |
Enumeration Date | 2011-06-23 |
Last Update Date | 2021-02-08 |