| NPI | 1154703841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 5541451-1204) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MO 2016028884) |
| 208600000X Surgery (Licence: MO 2016028884) | |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2022-12-30 |