NPI | 1730388976 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: LA DO.000426) |
Additional Taxonomies | 171000000X Military Health Care Provider |
208600000X Surgery (Licence: GA 62821) | |
Enumeration Date | 2007-07-17 |
Last Update Date | 2019-09-28 |