| NPI | 1629205182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL MD.34455) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 272632) |
| 208600000X Surgery (Licence: MA L-239969) | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2019-02-11 |