| NPI | 1548270861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD456515) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA04510100) |
| 2086S0102X Surgery Surgical Critical Care (Licence: NY 164843-1) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2018-11-12 |