| NPI | 1891094579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME123276) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 60.284987-1) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2016-09-13 |