NPI | 1639139256 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: TX S8572) |
Additional Taxonomies | 208600000X Surgery (Licence: NM MD2015-0807) |
Enumeration Date | 2006-03-27 |
Last Update Date | 2023-12-14 |