| NPI | 1174958961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: OH 34.013289) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL UO3447) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2020-11-30 |