| NPI | 1316286404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: NY 082665) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 082665) |
| Enumeration Date | 2013-02-08 |
| Last Update Date | 2013-02-08 |