| NPI | 1124229521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 46598) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 2825) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2024-02-16 |