| NPI | 1629003264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D63791) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A92803) |
| 208600000X Surgery (Licence: OK 29841) | |
| 208600000X Surgery (Licence: DC MD034439) | |
| 208600000X Surgery (Licence: NY 233310) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2015-06-25 |