| NPI | 1003857327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.054249) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: OH 35-054249) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2009-08-03 |