| NPI | 1922627397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NY 331257) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 331257) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2024-12-16 |