NPI | 1700034766 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: PA MD444229) |
Additional Taxonomies | 208600000X Surgery (Licence: PA MT 189899) |
208600000X Surgery (Licence: DE C1-0011143) | |
Enumeration Date | 2008-09-03 |
Last Update Date | 2020-08-21 |