| NPI | 1700838414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX L7939) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX L7939) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2022-01-25 |