| NPI | 1205026903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2011-00871) |
| Additional Taxonomies | 207PS0010X Emergency Medicine Sports Medicine (Licence: NC 2011-00871) |
| Enumeration Date | 2007-07-28 |
| Last Update Date | 2023-12-18 |