| NPI | 1699971705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX Q9457) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA09064000) |
| 208600000X Surgery (Licence: NY 262332-1) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2016-11-17 |