NPI | 1972983625 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: FL ME150802) |
Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA10697000) |
Enumeration Date | 2015-06-08 |
Last Update Date | 2021-07-29 |