| NPI | 1427097658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 3172A) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AK 5292) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: SD 1735) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2008-03-06 |