| 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 |