| NPI | 1720015894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: NY 202552) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 202552) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2023-09-18 |