| NPI | 1609137348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: PA OS017970) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS017970) |
| 2086S0127X Surgery, Trauma Surgery (Licence: NJ 25MB10043900) | |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2021-03-31 |