| NPI | 1861453730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX D7683) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX D7683) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2014-10-06 |