| NPI | 1083851356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: FL ME111396) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 252635) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2020-12-30 |