| NPI | 1750371746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 89809) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 1918411) |
| 2086S0129X (Licence: NY 1918411) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2023-08-29 |