| NPI | 1558780700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: AZ 58857) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 10785572-1205) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2021-03-09 |