| NPI | 1124681085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: ID M-17235) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: DC MD210002052) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: VA 0101274679) | |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: MD D0093893) | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2023-08-01 |