| NPI | 1164803284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61228859) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NJ 25MA10330200) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2022-08-22 |