| NPI | 1336502095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ R76033) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 267546) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2020-08-03 |