| NPI | 1558501668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 256590) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD436039) |
| 208600000X Surgery (Licence: CA A 113637) | |
| 208600000X Surgery (Licence: NJ 25IA12889700) | |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2026-06-15 |