| NPI | 1689617151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX H2748) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX H2748) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2020-12-17 |