| NPI | 1922413475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R9543) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2014018331) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2019-04-02 |