| NPI | 1194894923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MN 37645) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WI 29453-020) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2023-03-07 |