| NPI | 1932356003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 265951-01) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD483475) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2024-01-22 |