| NPI | 1891145728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 12656088-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 311714) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2023-11-13 |