| NPI | 1154703536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 28295) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WV 28295) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2022-04-05 |