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 | 2024-10-16 |