| NPI | 1942383658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 1270091) |
| Additional Taxonomies | 208600000X Surgery (Licence: VT 0420005078) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-07-08 |