| NPI | 1073640249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 119712) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 29106) |
| 208600000X Surgery (Licence: CT 17018) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2007-07-08 |