| NPI | 1851650329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 289662) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 289662) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2023-10-30 |