| NPI | 1275729311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 366442-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 70256) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 366442-1205) | |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2023-06-23 |