| NPI | 1962931451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: UT 13846498-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 67132) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2024-12-12 |