| NPI | 1023180544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: SC 83475) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MB07859300) |
| 208600000X Surgery (Licence: NY 235241) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2021-05-03 |