| NPI | 1619401775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NJ 25MA10138000) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA11411700) |
| Enumeration Date | 2017-04-16 |
| Last Update Date | 2024-08-14 |