NPI | 1295885309 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: KY 23688) |
Additional Taxonomies | 208600000X Surgery (Licence: TN 61892) |
208600000X Surgery (Licence: GA 074380) | |
Enumeration Date | 2007-01-11 |
Last Update Date | 2021-10-19 |