| NPI | 1730590530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.152459) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA10535900) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2025-07-17 |