| NPI | 1770803892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: OR MD169780) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD169780) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2021-01-14 |