| NPI | 1568753945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: NJ 25MA08796100) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA08796100) |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2021-04-23 |