| NPI | 1386859684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 138892) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 138892) |
| 2086X0206X Surgery, Surgical Oncology (Licence: NY 138892) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2007-07-09 |