| NPI | 1891059747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PR 19042) |
| Additional Taxonomies | 207PS0010X Emergency Medicine Sports Medicine (Licence: PR 19042) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2021-08-25 |