| NPI | 1104489103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA12799500) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NJ 25MA12799500) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2025-09-19 |