| NPI | 1982848156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 252470-1) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0102202375) |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2010-07-27 |