| NPI | 1568552016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 166361) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 166361-6) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2017-04-20 |