| NPI | 1073567251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MS 18315) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MS 18315) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2011-10-12 |