| NPI | 1982196218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: RI MD20640) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP04314) |
| 208600000X Surgery (Licence: NY 329166) | |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2025-06-12 |