| NPI | 1306107644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB10425100) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA OP60738550) |
| 208600000X Surgery (Licence: NY 271919) | |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2018-08-23 |