| NPI | 1578978029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2014020167) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2019029088) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2020-06-03 |