| NPI | 1063039824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 13323091-1205) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: UT 13323091-1205) |
| Enumeration Date | 2020-06-28 |
| Last Update Date | 2023-08-23 |