| NPI | 1104039072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: MI 5101015741) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101015741) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2008-03-06 |