| NPI | 1740210368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 13791) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NH 13791) |
| 208600000X Surgery (Licence: MS 17654) | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NC 94-00431) | |
| 207P00000X Emergency Medicine (Licence: MS 17654) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2019-07-30 |