| NPI | 1245760818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 71357-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.070938) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2021-07-06 |