| NPI | 1336199512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 262873) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 21777) |
| 208600000X Surgery (Licence: SC 21777) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2016-02-19 |