NPI | 1720387319 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: CA A121442) |
Additional Taxonomies | 208600000X Surgery (Licence: NC 2013-01981) |
208600000X Surgery (Licence: NJ 25MA09005600) | |
208600000X Surgery (Licence: NM MD2015-0456) | |
Enumeration Date | 2011-03-22 |
Last Update Date | 2025-07-23 |