| NPI | 1376596981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2012003239) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 31881) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: WA MD000045375) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2022-04-19 |