| NPI | 1306031893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: PA MD435905) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD435905) |
| Enumeration Date | 2007-09-08 |
| Last Update Date | 2025-10-27 |