| NPI | 1710149356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: NY 254698) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA08347800) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2018-04-02 |