| NPI | 1487850053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2007006893) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2007006893) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2023-11-01 |