| NPI | 1760841423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: TN 70735) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 30650) |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2025-06-20 |