NPI | 1386031839 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: NY 303574) |
Additional Taxonomies | 208600000X Surgery (Licence: OH 57026303) |
Enumeration Date | 2015-04-22 |
Last Update Date | 2021-01-06 |