| NPI | 1194820522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 00026177) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 00026177) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2012-03-01 |