| NPI | 1124361019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: ID M-17457) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 262950) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: PA MT203211) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NY 262950) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: IN 01088790A) | |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2023-10-18 |