| NPI | 1053471102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL ME164763) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00030715) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2024-02-09 |