| NPI | 1417260845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: NY 254031) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 254031) |
| 208D00000X General Practice (Licence: NY 254031) | |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2010-07-14 |