| NPI | 1003877473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D57744) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101057847) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MD D57744) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0101057847) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2011-10-21 |