| NPI | 1568959690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2026-02849) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NC 2026-02849) |
| Enumeration Date | 2018-04-14 |
| Last Update Date | 2026-07-29 |