| NPI | 1770698136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A38229) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 14023) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2016-10-03 |