| NPI | 1902877822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 241735) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 241735) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2013-07-18 |