NPI | 1225201148 |
---|---|
Entity Type | Individual |
Gender | Male |
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 |