| NPI | 1912214503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A133575) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA A133575) |
| 208600000X Surgery (Licence: MI 4301096858) | |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2026-04-03 |