| NPI | 1760740708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: VA 0101257966) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID M13319) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2017-08-28 |