| NPI | 1649364902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 047775) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 000000A52737) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: CO 047775) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2009-08-10 |