| NPI | 1619331253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101269982) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: VA 0101269982) |
| Enumeration Date | 2016-04-10 |
| Last Update Date | 2024-02-22 |