| NPI | 1114330677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 296101) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 296101) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2021-07-21 |