| 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 |