| NPI | 1447216981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MA 295469) |
| Additional Taxonomies | 2086S0129X (Licence: CT 56042) |
| 2086S0129X (Licence: RI MD15696) | |
| 2086S0129X (Licence: NY 214947) | |
| 2086S0129X (Licence: NH 16212) | |
| 208600000X Surgery (Licence: NY 214947) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2026-03-04 |