| NPI | 1841345725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101260704) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 149086) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2023-03-29 |