| NPI | 1255417192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL ME70920) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MT 115184) |
| 207P00000X Emergency Medicine (Licence: UT 12927389-1205) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2022-10-03 |