| NPI | 1366556656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine Sports Medicine (Licence: MI 5101012376) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101012376) |
| 207PS0010X Emergency Medicine Sports Medicine (Licence: OH 34.011326) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2021-03-26 |