| NPI | 1942374178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P7799) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO 52479) |
| 208600000X Surgery (Licence: NY 233425) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2022-01-21 |