| NPI | 1023093622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 7561A) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: MI 5101014814) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2010-03-23 |