NPI | 1649617101 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: CT 69317) |
Additional Taxonomies | 208600000X Surgery (Licence: NC 2018-00276) |
208600000X Surgery (Licence: VA 0101267191) | |
Enumeration Date | 2013-05-23 |
Last Update Date | 2021-09-08 |