| NPI | 1396960399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WA MD60078946) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI LP00010) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2013-02-06 |