| NPI | 1134174949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WI 61479) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 30773) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2014-01-24 |