| NPI | 1013234475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 263666) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 263666) |
| 146N00000X Emergency Medical Technician, Basic (Licence: NY 270618) | |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2014-07-17 |