| NPI | 1134375512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 296023) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 296023) |
| Enumeration Date | 2008-08-17 |
| Last Update Date | 2023-05-01 |