| NPI | 1699060590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 257614) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 257614) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2011-07-08 |