| NPI | 1073819314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO184177) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OK 4925) |
| Enumeration Date | 2011-02-03 |
| Last Update Date | 2017-10-04 |