| NPI | 1437491628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2016-01317) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NC 2016-01317) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2026-06-05 |