| NPI | 1760452064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME121873) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 42667) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2016-06-06 |