| NPI | 1407910219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2018-00970) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 215797) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2023-02-24 |