| NPI | 1285611178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: CT 36193) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 179518) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2019-01-04 |