| NPI | 1851329429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 30319-020) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 30319-020) |
| 207Q00000X Family Medicine (Licence: WI 30319-020) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2008-05-29 |