| NPI | 1295161586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2016-02569) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 32,455R) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: NC 2016-02569) | |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2018-06-15 |