| NPI | 1447417480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101244542) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.012408) |
| 208600000X Surgery (Licence: NY 250211) | |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2013-07-30 |