| NPI | 1790072932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 56512) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 58-2329008) |
| 208600000X Surgery (Licence: NY 289535) | |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2025-10-02 |