| NPI | 1346655636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2014018317) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2014018317) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2014-06-25 |