| NPI | 1477992279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA MD-49785) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 57101) |
| 208600000X Surgery (Licence: NY 310138) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2024-02-25 |