| NPI | 1730303736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 096114-1) |
| Additional Taxonomies | 2086H0002X Surgery Hospice and Palliative Medicine (Licence: NY 096114) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2025-11-09 |