| NPI | 1427211457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 56993) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD461771) |
| 208600000X Surgery (Licence: NY 270933) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2022-09-26 |