| NPI | 1497117972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 52981) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY TP566) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: KY TP566) | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2020-11-30 |