| NPI | 1013584382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: NC 2024-01464) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: GA 12918) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2024-06-29 |