| NPI | 1447982327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT022961) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL87676) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2025-08-21 |