NPI | 1578825055 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: SC 87668) |
Additional Taxonomies | 208600000X Surgery (Licence: PA MT201891) |
208600000X Surgery (Licence: MI 4301502766) | |
Enumeration Date | 2012-06-12 |
Last Update Date | 2022-10-11 |