| NPI | 1801180732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101276513) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 300064) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2022-12-08 |