| NPI | 1720139892 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60070594) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 234147) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2023-07-20 |