| NPI | 1659315356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MD D80156) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NJ 25MA07029700) |
| 171000000X Military Health Care Provider (Licence: TN MD0000042297) | |
| 208600000X Surgery (Licence: PA MD442554) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD442554) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-12-05 |