| NPI | 1003823808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine Sports Medicine (Licence: UT 5212953-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 52129531205) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2014-10-14 |