| NPI | 1093747776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MS 18987) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 18987) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2023-03-24 |