| NPI | 1649420464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA08703400) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 249264) |
| 208600000X Surgery (Licence: FL ME 118245) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NJ 25MA08703400) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NY 249264) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME 118245) | |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2014-01-21 |