| NPI | 1174615017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 049078) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: CT 049078) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CT 049078) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2021-10-13 |