| NPI | 1679590525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 214317) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 044566) |
| 208600000X Surgery (Licence: OH 35-096712) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2022-10-31 |