NPI | 1356544282 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: FL ME112612) |
Additional Taxonomies | 208600000X Surgery (Licence: FL TRN11572) |
Enumeration Date | 2007-06-07 |
Last Update Date | 2019-04-17 |