| NPI | 1164483376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME53998) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME 53998) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2015-02-19 |