| NPI | 1962709865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD446089) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 292005) |
| Enumeration Date | 2011-02-12 |
| Last Update Date | 2024-01-29 |