| NPI | 1477973592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD486109) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NJ 25IA13097500) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2026-06-18 |