| NPI | 1215381058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WA 60937363) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 291660) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2021-12-04 |