| NPI | 1104036912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: MN 52029) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 52029) |
| 207P00000X Emergency Medicine (Licence: MA 232248) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2023-06-13 |