| NPI | 1952351777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A17467) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 006810) |
| 208600000X Surgery (Licence: NY 200259) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2019-12-03 |