| NPI | 1407103534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 308073) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 51956) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2021-01-21 |