| NPI | 1003817453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: KY 35029) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 35029) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2021-03-23 |