| NPI | 1669674909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 067748) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 23837) |
| 208600000X Surgery (Licence: NY 239120) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2019-09-06 |