| NPI | 1205871878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NY 310489) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD426367) |
| 207P00000X Emergency Medicine (Licence: NJ 25MA10343100) | |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: NJ 25MA10343100) | |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2023-08-10 |