| NPI | 1265591333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NH 15082) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA08112300) |
| 208600000X Surgery (Licence: VT 0420012117) | |
| 2086S0129X (Licence: CO DR.0051749) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2019-01-08 |