| NPI | 1396165445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME137154) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 311124) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2018-10-31 |