| NPI | 1255835609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine Sports Medicine (Licence: WA MD61140082) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD203555) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2023-07-18 |