| NPI | 1295029148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WA MD60455396) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125.059410) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2019-10-25 |