| NPI | 1528590346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MS 27979) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.013926) |
| 207P00000X Emergency Medicine (Licence: TN 5531) | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2024-03-18 |