| NPI | 1225141369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NH 11842) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 058239) |
| 208600000X Surgery (Licence: NY 246508) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2013-02-06 |