| NPI | 1023364999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS17869) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PT41787) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2021-06-10 |