| NPI | 1417510298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME151714) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME151714) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: FL ME151714) | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2023-12-21 |