| NPI | 1578509725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MS 16905) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 00022961) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2010-07-02 |