| NPI | 1780630392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD418397) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ ma079207) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NJ ma076933) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2016-12-05 |