| NPI | 1942255021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: NY 200140) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 200140) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2021-12-01 |