| NPI | 1023051760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NV 8687) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 5710391205) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 204739) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2007-07-08 |