NPI | 1275672347 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 202K00000X (Licence: TX M6646) |
Additional Taxonomies | 208600000X Surgery (Licence: CO 45278) |
208600000X Surgery (Licence: TX M6646) | |
Enumeration Date | 2007-02-05 |
Last Update Date | 2016-05-04 |