NPI | 1730319336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 193400000X Single Specialty (Licence: IL 036.141461) |
Additional Taxonomies | 208600000X Surgery (Licence: MI 4301095093) |
208600000X Surgery (Licence: NC 2015-00961) | |
Enumeration Date | 2009-07-17 |
Last Update Date | 2016-09-01 |