| NPI | 1972720381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD205462) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 07117R) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2015-12-07 |