| NPI | 1033191796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: HI MD11409) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MS 09201) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2007-07-08 |