| NPI | 1386058394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 292439) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 292430-01) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2020-03-30 |