| NPI | 1053360040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: GA 057906) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301081769) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2007-07-08 |