| NPI | 1003908195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 4184) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 1364) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NV 1364) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2009-08-14 |