NPI | 1780659276 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: CA 20A10859) |
Additional Taxonomies | 208600000X Surgery (Licence: OH 34010762) |
Enumeration Date | 2006-02-20 |
Last Update Date | 2021-11-18 |