| NPI | 1922530252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine Sports Medicine (Licence: MI 4301507290) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 287482) |
| 207P00000X Emergency Medicine (Licence: IL 125069944) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MA 287482) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2022-10-04 |