| NPI | 1801842703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: WY 10122A) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: MO 2002013028) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: SD 8867) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2015-11-10 |