| NPI | 1770517849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.09420R) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 09420R) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2019-06-25 |