| NPI | 1346278264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: FL ME67309) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME67309) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2013-02-28 |