| NPI | 1780649343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 175996) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 175996) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2023-08-31 |