| NPI | 1225524879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD488408) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA11878300) |
| 2086S0102X Surgery Surgical Critical Care (Licence: PA MD488408) | |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2025-08-13 |