| NPI | 1003205956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 273152) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: MA 273152) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: MA 273152) | |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2021-05-03 |