| NPI | 1619927407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 254284) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV 9758) |
| 208600000X Surgery (Licence: AZ 47994) | |
| 208600000X Surgery (Licence: CA 129128) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2016-11-01 |