| NPI | 1376754390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NY 288141) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301084534) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2018-03-17 |