| NPI | 1710149950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 89561) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 266187) |
| 208600000X Surgery (Licence: CA A136120) | |
| 208600000X Surgery (Licence: FL ME123106) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2022-03-07 |