| NPI | 1760429476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: VA 0102204828) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DC DO034203) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2023-04-13 |