| NPI | 1386728152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 11731) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MS 11731) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2017-08-09 |