| NPI | 1194110130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 289316) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 89624) |
| 208600000X Surgery (Licence: CT 83128) | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2025-10-29 |