NPI | 1750708780 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: FL ME162710) |
Additional Taxonomies | 208600000X Surgery (Licence: IL 036144792) |
208600000X Surgery (Licence: NJ 25MA10886700) | |
Enumeration Date | 2014-03-27 |
Last Update Date | 2024-01-24 |