| NPI | 1093928079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 255566) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5315026344) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2023-11-27 |