| NPI | 1033370028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 2860136) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP01469) |
| 208600000X Surgery (Licence: RI MD14237) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2016-08-25 |