| NPI | 1386888477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09685400) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NJ 25MA09685400) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2021-02-23 |