| NPI | 1013363464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: FL ME139617) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME139617) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: FL ME139617) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2023-08-07 |