| NPI | 1609843424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D84211) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 15634R) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: LA 15634R) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2018-11-17 |