| NPI | 1427225317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2022-03263) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 267683) |
| Enumeration Date | 2008-05-11 |
| Last Update Date | 2023-10-05 |