| NPI | 1790992261 |
|---|---|
| Other Name | KENNY LEROY WATTS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2013032884) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 25530) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2013-10-25 |