NPI | 1376744979 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0129X (Licence: FL ME118812) |
Additional Taxonomies | 208600000X Surgery (Licence: NC 2025-00439) |
2086S0129X (Licence: NC 2025-00439) | |
Enumeration Date | 2007-05-30 |
Last Update Date | 2025-04-23 |