| NPI | 1144351156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 247373) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NY 2550856) |
| 282NC0060X General Acute Care Hospital, Critical Access (Licence: NY 00246048) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2021-12-17 |