| NPI | 1184606493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 33875) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: IA 33875) |
| 207P00000X Emergency Medicine (Licence: IA BA6060913) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2021-04-02 |