NPI | 1396301602 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: TX U9878) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX U9878) |
Enumeration Date | 2019-05-13 |
Last Update Date | 2024-08-01 |