| NPI | 1730310970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0102205535) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 262200) |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2025-04-15 |