| NPI | 1174505481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 101878) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: IA 03217) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2015-03-12 |