| NPI | 1174763957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CT 55618) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 55618) |
| 208600000X Surgery (Licence: MA 241896) | |
| 208600000X Surgery (Licence: NY 248565-1) | |
| 2086S0129X (Licence: RI MD15597) | |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2022-03-10 |