| NPI | 1164084109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME169749) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 71588) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL ME169749) | |
| Enumeration Date | 2019-06-30 |
| Last Update Date | 2024-07-23 |