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 |