| NPI | 1750402681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX M4472) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A100964) |
| 208600000X Surgery (Licence: NY 242179-1) | |
| 208600000X Surgery (Licence: OH 35125461) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2018-11-26 |