| NPI | 1619927183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 168613) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 8694) |
| 208600000X Surgery (Licence: ME MD20948) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2016-04-13 |