| NPI | 1205883766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MA 227795) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 51947-20) |
| 207P00000X Emergency Medicine (Licence: IL 036113654) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2008-10-07 |