| NPI | 1518908169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0101367586) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101036758) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: MD D35461) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2010-08-09 |