| NPI | 1538556196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 312196) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2020-00407) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2022-01-11 |