NPI | 1790072932 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: CT 56512) |
Additional Taxonomies | 208600000X Surgery (Licence: GA 58-2329008) |
208600000X Surgery (Licence: NY 289535) | |
Enumeration Date | 2011-07-08 |
Last Update Date | 2025-10-02 |