NPI | 1790070605 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: PA MD458697) |
Additional Taxonomies | 208600000X Surgery (Licence: MI 4301098825) |
Enumeration Date | 2011-06-20 |
Last Update Date | 2016-07-20 |