| NPI | 1518279470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME115884) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301096939) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL ME115884) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2024-07-23 |