NPI | 1396703625 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: NM MD2010-0595) |
Additional Taxonomies | 174400000X Specialist (Licence: TX M0961) |
Enumeration Date | 2006-05-03 |
Last Update Date | 2017-02-02 |