NPI | 1285048041 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: ID O-1628) |
Additional Taxonomies | 208600000X Surgery (Licence: MI 5101021200) |
208600000X Surgery (Licence: WA OP60938412) | |
Enumeration Date | 2014-06-19 |
Last Update Date | 2022-03-15 |