| NPI | 1629228549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 88575) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 258336) |
| 208600000X Surgery (Licence: MA 239419) | |
| Enumeration Date | 2008-09-27 |
| Last Update Date | 2022-09-19 |