| NPI | 1780676544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 188144) |
| Additional Taxonomies | 208600000X Surgery (Licence: VT 042.0006375) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2014-02-01 |