| NPI | 1457512642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME 112344) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: FL ME 112344) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2015-06-09 |