| NPI | 1063478139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: GA 057269) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 37295) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2015-06-08 |