| NPI | 1659345221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WY 8000A) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M-10577) |
| 208600000X Surgery (Licence: NY 147502) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2015-01-03 |