| NPI | 1396779716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60793240) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 41606-020) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WY 9372-A) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NM MD2014-0522) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-08-15 |