| NPI | 1407013295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME107554) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: FL ME107554) |
| 207P00000X Emergency Medicine (Licence: KS 04-33108) | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2015-08-05 |