| NPI | 1619339504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL MD.38553) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: AL MD.38553) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2020-05-29 |