NPI | 1891227625 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: FL ME138836) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 29727) |
207P00000X Emergency Medicine (Licence: PA MD470775) | |
Enumeration Date | 2017-03-30 |
Last Update Date | 2024-11-04 |