| NPI | 1700859683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 219020) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD426099) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2008-03-12 |