| NPI | 1477674562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 286029) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 15643) |
| 208600000X Surgery (Licence: NC 2013-01267) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2016-09-20 |