| NPI | 1245231448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 2212) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 51) |
| 207P00000X Emergency Medicine (Licence: SD 4795) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IA 2212) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2007-12-10 |