NPI | 1366947756 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: MD D0104641) |
Additional Taxonomies | 208600000X Surgery (Licence: PA MD484666) |
Enumeration Date | 2018-03-27 |
Last Update Date | 2025-08-21 |