| NPI | 1992325435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NY 336002) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: CA A209548) |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2026-06-24 |