| NPI | 1487653291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0101256957) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 13459) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2020-01-31 |