| NPI | 1881856532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: KY 44844) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 44844) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2015-05-09 |