| NPI | 1003054214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 263018) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME128544) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2018-03-17 |