| NPI | 1043479595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MA 249589) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA09862800) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NJ 25MA09862800) | |
| 208600000X Surgery (Licence: MA 249589) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2026-05-30 |