| NPI | 1659395937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: NY 135398) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 135398) |
| 2086S0127X Surgery Trauma Surgery (Licence: NY 135398) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2011-12-14 |