| NPI | 1902830755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: MI 4301085729) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301085729) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2026-04-27 |