| NPI | 1477972149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2016-02586) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101259330) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0101259330) | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2018-06-13 |