| NPI | 1508010273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY AN0768917 I 07) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY AL4849622 j14) |
| 208600000X Surgery (Licence: NY MMIS00243903) | |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2008-11-07 |