| NPI | 1154345973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NE 16542) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 0436174) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2015-04-14 |