| NPI | 1710906136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 212039) |
| Additional Taxonomies | 208600000X Surgery (Licence: VT 042.0012371) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2014-11-11 |