| NPI | 1770788689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 42222) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME98414) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2016-01-18 |