| NPI | 1154364891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 359440) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 78119) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2024-11-07 |