| NPI | 1710973243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: NY 225720) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: NJ MB67018) |
| 208600000X Surgery (Licence: NJ 25MB0670800) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2020-07-24 |