NPI | 1306107644 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB10425100) |
Additional Taxonomies | 208600000X Surgery (Licence: WA OP60738550) |
208600000X Surgery (Licence: NY 271919) | |
Enumeration Date | 2012-06-04 |
Last Update Date | 2018-08-23 |