| NPI | 1457467649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM 97-391) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM 97391) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2019-11-07 |