| NPI | 1902095466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MS 22691) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 30358) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2022-01-03 |