| NPI | 1588998850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2021-01685) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 238008-1) |
| Enumeration Date | 2009-09-19 |
| Last Update Date | 2022-03-01 |