| NPI | 1700907292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 161913) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 161913-1) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2018-04-04 |