| NPI | 1780892943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 45864) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 60-239727) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: NY 60-239727) | |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2022-08-29 |