| NPI | 1336533876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VT 042.0016423) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 290337) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2022-09-22 |