| NPI | 1316131352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY MD145740) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY MD145740) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2007-09-04 |