| NPI | 1073775284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 270656) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301092552) |
| Enumeration Date | 2008-06-29 |
| Last Update Date | 2023-09-27 |