| NPI | 1487181491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2021017141) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA R-10843) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: AZ 60686) | |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: MO 2021017141) | |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2022-09-12 |