| NPI | 1932427069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NE 28791) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA R-8823) |
| 207P00000X Emergency Medicine (Licence: IA 40647) | |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2015-09-04 |