| NPI | 1619387099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: FL OS15506) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 04183) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KY TP002) | |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2024-01-18 |