| NPI | 1265455596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AR C-6367) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 66638-20) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2017-03-06 |