NPI | 1750794517 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: WA MD61059349) |
Additional Taxonomies | 208600000X Surgery (Licence: OR 125064540) |
Enumeration Date | 2014-06-09 |
Last Update Date | 2020-10-14 |