| NPI | 1033594288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS T3061) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL UO4243) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2020-01-17 |