| NPI | 1437130671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2009-0157) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 217216-1) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2017-03-22 |