| NPI | 1245324359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NY 231751) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 231751) |
| 208600000X Surgery (Licence: MI 4301091453) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NY 231751) | |
| 2086S0129X (Licence: CT 046504) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-04-14 |