| NPI | 1356509384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 55511) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA R-8343) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WI 55511) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IA 38698) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2017-06-22 |