| NPI | 1063624971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME164465) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY p55999) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2023-09-05 |