| NPI | 1972899607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB09897700) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: NJ 25MB09897700) |
| 2086S0102X Surgery Surgical Critical Care (Licence: NJ 25MB09897700) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2022-07-21 |