| NPI | 1356336127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A44933) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 36455) |
| 207P00000X Emergency Medicine (Licence: CA A44933) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2026-10-08 |