| NPI | 1871913269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 299760) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0092251) |
| 208600000X Surgery (Licence: VA 0101272870) | |
| 208600000X Surgery (Licence: DC MD9911308) | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2021-10-07 |