| NPI | 1487065751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME123175) |
| Additional Taxonomies | 207PS0010X Emergency Medicine Sports Medicine (Licence: FL ME123175) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2021-10-23 |