| NPI | 1407292907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: AZ 52249) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 52249) |
| Enumeration Date | 2013-05-12 |
| Last Update Date | 2022-01-21 |