| NPI | 1447659099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME143286) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY AL4978841-1440) |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2022-07-11 |