| NPI | 1023158771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 33956) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: NY 139319) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: IL 036094967) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2013-06-25 |