| NPI | 1225201148 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: ID M-12527) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 5298339-1205) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: UT 5298339-1205) | |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2020-04-13 |