| NPI | 1700349966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NC 2023-00804) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2023-00804) |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2026-07-13 |