| NPI | 1548385388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 23139) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 23139) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |