| NPI | 1609281153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2014018353) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60826310) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2018-06-06 |