| NPI | 1790752764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 158539) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 158539) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: NY 458539) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2014-12-04 |