NPI | 1417906991 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: WA AA8830778) |
Additional Taxonomies | 208600000X Surgery (Licence: PA MD421172) |
Enumeration Date | 2006-05-10 |
Last Update Date | 2019-01-24 |