| NPI | 1437148228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 123994) |
| Additional Taxonomies | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: NY 123994) |
| 2086S0129X Surgery Vascular Surgery (Licence: NY 123994) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2013-01-15 |