| NPI | 1083173926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 51012) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2021-03371) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: AL 51012) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-07-16 |