| NPI | 1942284047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC MD36329) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 130772) |
| 208600000X Surgery (Licence: MS 21260) | |
| 208600000X Surgery (Licence: ME TD141049) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: SC MD36329) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2015-08-20 |